Outreach Activity Request Form

1. Contact person for the activity:

*
*
Telephone Number*
()-
*
2. Purpose of the activity:*
(Please indicate what you would like the Commission to do.)



3. When and where would you like to schedule the activity:

*
Today
*
4. Subject to discuss:
(Indicate what areas you are interested in learning about.)
5. Number of people expected to attend the activity:
6. Will the participants be:*


7. Is there any other information you would like to share with us to help us ensure the outreach activity satisfies your needs?
8. Will audio and/or video equipment be available for use with the presentation?

Item marked with an * is mandatory.